Having a transjugular liver biopsy

Transcription

1 Having a transjugular liver biopsy Department of Radiology Information for Patients i Radiology Leaflet No. 54 University Hospitals of Leicester NHS Trust

2 Introduction Please read your appointment letter carefully to check which hospital you must attend for your appointment. This leaflet tells you about the procedure called transjugular liver biopsy. It explains what is involved and what the possible risks are. 1. Referral and consent The doctor who referred you should have discussed the reasons for needing a liver biopsy. You should make sure that you understand these reasons, the procedure itself, any risks involved and the success rates. The consultant or the radiologist (a specialised X-ray doctor) who will be performing the biopsy will ask you to sign a consent form. When you sign this it means you have agreed to have the biopsy done and that you understand why it is needed. You should have had sufficient explanation before you sign the consent form. You will have a copy of the consent form to take away. If after discussion with your hospital doctor or radiologist you do not want the procedure carried out, then you can decide against it. If you feel during the procedure that you do not want it to continue we will explain the implications of not doing so to help you fully decide. If the radiologist feels that your condition has changed or that your symptoms do not indicate the procedure is necessary then they will explain this to you. The radiologist will let the doctor who referred you know so that they can see you again to review your condition. At all times the radiologist and referring doctor will be acting in your best interests. 2

3 2. What is a transjugular liver biopsy? Your doctors would like to take a piece of your liver tissue to send to be examined under the microscope. This is to help them with your diagnosis and treatment. Most liver biopsies are taken directly from the liver with a needle through the skin. In your case, because of the difficulties with blood clotting, fluid in the abdomen or because of the shape of your liver, a different approach is needed. The approach is through a vein in the side of your neck. The radiologist will direct a small tube (a catheter) from here into the veins inside the liver guided by an x-ray camera. The radiologist may inject a contrast medium (a clear liquid that shows up on x-rays) to take pictures of your liver veins. 3. Important information If you are on medication from your doctor, please continue to take it as normal with the exception of medication that thins the blood. If you are taking medication that thins the blood please contact the Radiology Department for advice. These drugs include Rivaroxaban, warfarin, clopidogrel (Plavix) or Dalteparin / Heparin injections. When you arrive at the room for the procedure, please tell the staff if: You are diabetic You have any allergies You have reacted previously to an intravenous contrast medium, the dye used for kidney X-rays and CT scanning You may be pregnant 3

4 3. Important information (continued) Your blood will have to be tested for clotting and platelet count. If these are very abnormal your doctors may give you a transfusion of platelets or plasma. You will be given antibiotics before the procedure to reduce the risk of infection. 4. How do I prepare for the procedure? Do not have anything to eat (except your medicines) for 4 hours before the procedure. It is important that you continue to drink clear fluids until one hour before your appointment time. Take all of your usual morning medications and bring all your usual medication with you. You will be asked to put on a hospital gown and disposable pants before the procedure. 5. What happens during the procedure? You will be taken to the X-ray department and transferred onto the X-ray table. Everything will be kept sterile and the radiologist will wear a theatre gown and sterile gloves. You will have a cannula (small plastic tube) placed in a vein in your arm so that you may be given medication if necessary. You will be monitored during the procedure by a qualified nurse who will be checking your blood pressure, pulse and oxygen saturation levels. You may be given a light sedative to relax you. You will not necessarily go to sleep. 4

5 5. What happens during the procedure? (continued) The right side of your neck will be cleaned with antiseptic fluid and will be covered by a sterile towel. The radiologist may do an ultrasound scan of your neck to see the veins before giving you an injection of local anaesthetic. The right side is used in most cases but sometimes we have to use the left side if the right jugular vein is blocked or too small. After the local anaesthetic has been given, a small tube (called a catheter) about the size of a piece of spaghetti will be inserted into the neck vein using an ultrasound machine to guide it. The radiologist will then direct the catheter through your veins into position inside the liver and will perform the biopsy. You may feel some discomfort in your neck when the tube is inserted and in your abdomen when the biopsy is taken. If you are troubled by pain or are very tense you can have further sedative or painkillers. 6. How long will the procedure take? The procedure usually takes between 30 and 60 minutes. If other tests are being performed the procedure may take longer. 7. What happens after the procedure and when I go home? All the tubes will be removed and the radiologist or nurse will press on your neck where the tube was inserted. You will be taken back to the ward in your bed. You must stay in bed for at least 6 hours. 5

6 7. What happens afterwards? (continued) The nurse will check your pulse and blood pressure regularly. You can eat and drink normally after 2 hours as long as you are fully recovered from the sedative. You will usually be asked to stay in hospital until at least the following day. You will need someone to drive you home. You will have a small puncture and may have a bruise on your neck. This should heal up within a few days leaving only a very small mark. If you have any serious pain or any sign of bleeding anywhere after the procedure you should tell the doctor or nurse straight away. If you have any pain this can be relieved by taking your usual painkiller. However, if your usual painkiller is aspirin, it is recommended that you use a different painkiller. Should your usual painkiller be ineffective you should see your GP. If your job involves strenuous exercise or heavy lifting it is advisable to request light duties. You will have had some sedation so please follow the advice below. FOR 12 HOURS: You must be accompanied by a responsible adult. FOR 24 HOURS: Do not: Drink alcohol Operate any machinery or do anything requiring skill or judgement Make important decisions or sign any documents Climb ladders Return to work until after this period of time FOR 3 DAYS: Do not: Drive a car or ride a bicycle Take any strenuous exercise or heavy lifting 6

7 8. Checking your wound site The small needle puncture site in your neck usually stops bleeding immediately on sitting up after the procedure. Occasionally a pressure bandage is necessary for a few hours, particularly if there is a problem with blood clotting. Unexpected delayed bleeding is very rare and may be stopped by applying direct firm pressure while you call for medical help. 9. Are there any risks or complications? As with any procedure or operation, complications are possible. We have included the most common risks and complications in this leaflet. The possibility of these complications happening to you will be discussed with you before you sign the consent form. Minor complications - The risk of a minor complication is about 6% (six in 100 patients). The majority of these complications are bruising or bleeding in your neck or fever. Bruising - A small bruise in the neck is common but not usually serious. Sometimes if the blood clotting is very abnormal there may be some bleeding from the puncture site. This usually stops easily if the nurse presses on it or puts on a pressure bandage. Major complications - The risk of a major complication is about 0.5% (one in 200 patients). Major complications can be bruising or bleeding in the liver, bleeding into the abdomen or irregular heartbeats. 7

8 9. Are there any risks or complications? (continued) Bleeding - Any biopsy carries a small risk of bleeding internally. Very rarely there is bleeding from a vein or artery within the neck or chest or from the liver itself as a result of the procedure. This procedure is designed to minimise the risk of bleeding compared to a standard liver biopsy. If there is any serious bleeding then further procedures, blood transfusion or an operation may be advised. If you have any unexpected pain or signs of bleeding anywhere please tell the doctor or nurse (even if you have already been discharged from hospital). Irregular heart beats - Sometimes the tube passing through the heart towards the liver can cause irregular heartbeats. This usually returns to normal within a few seconds. Risk of death - There is a risk of death following a transjugular liver biopsy. This rate is about 1 patient in every 1000 transjugular liver biopsies. Any complications that you suffer will be treated quickly and as fully as possible. There is a small risk that the biopsy will fail to get an adequate sample for diagnosis. In some cases a repeat procedure or a different procedure can be done to overcome this. If this happens your doctors will discuss the options with you. Contrast medium - some patients may be allergic to the contrast agent and may have symptoms such as nausea, vomiting or a rash. You will have been asked questions to see if you are likely to be allergic to the contrast media. If you develop symptoms at home you should contact your GP. 8

9 10. How do I get the results? The liver sample is sent to the laboratory. Your doctors will tell you the findings as soon as they can. Preliminary reports are sometimes available the next day but often the analysis takes a few more days. If required you will be able to come back to the outpatient clinic to discuss your results. Any questions? If you have any questions write them down to remind you what to ask when you speak to your consultant. 9

10 Support for people with learning disabilities There is support available in our hospitals for patients with learning disabilities. Please contact the learning disability specialist nursing team on (0116) telling them when the appointment is and what examination has been booked. Other sources of information Websites For general information about radiology departments visit the Royal College of Radiologists website: For information about the effects of x-rays read the NRPB publication: X-rays how safe are they, on the Health Protection Agency website: Please note that the views expressed in these websites, do not necessarily reflect the views of UHL or the NHS. University Hospitals of Leicester website: NHS Direct: For health advice or information you can call NHS on:

11 Additional hospital information How was it for you? If you wish to make any comments or suggestions regarding your visit to the Radiology Department please fill in a suggestion form or speak to a member of staff. Suggestion forms are located in all waiting areas within the department. University Hospitals of Leicester NHS Trust also has a Patient Information and Liaison Service (PILS), and you are welcome to contact them on: Freephone: pils.complaints.compliments@uhl-tr.nhs.uk We review our information leaflets on a regular basis. If you have any comments about how we can improve these leaflets please speak to a member of staff. Directions and car parking For information about getting to the hospital please see the hospitals website: Hospital car parking is available to all hospital patients and visitors. Spaces are limited so please allow plenty of time to find a car parking space. Parking charges are payable, please check tariff boards or the hospital website for full details. As well as the hourly rates there are a range of saver tickets available for patients and prime carers. Dedicated disabled parking bays are also available. Marked disabled bays exist outside of the public car parks for which there is no charge. If you park in the car parks the fee will apply. 11

12 Additional hospital information (continued) Drop off bays exist at the main entrances, these bays have a 20 minutes maximum stay. Certain qualifying benefits as notified by the Department of Social Security entitle the patient to free or reduced parking. For more information contact the Cashiers office. Bus services to the hospital Our aim is to ensure that there are car parking spaces available for those who really need to use them. We encourage you to use public transport or walk to the hospital if you are fit and well. For information on bus routes and times contact Traveline on Our Hospital Hopper shuttle bus service links our three hospitals with Beaumont Leys Centre, Hamilton Centre, the Railway station and St Nicolas Place (Park and Ride hub). The buses run from 6:30am until 7pm every 30 minutes from Monday to Friday. The nationally recognised concessions are valid on buses in Leicester including the Hospital Hopper. Relatives and escorts You may wish to bring a friend or relative to accompany you to and from the Radiology Department when you have your examination although they may not always be allowed into the examination room. This may be useful if you do not understand English very well or if you have any special needs. 12

13 Additional hospital information (continued) Children Baby changing facilities are available. Please ask to be shown to them if you wish to use them. We are unable to offer childcare facilities. If you need to bring your children with you, please bring along an adult who can supervise them whilst your examination is being carried out. Radiology staff are not able to supervise your children. Facilities available Refreshments: Refreshments including hot and cold drinks are available in the hospital. Please ask a member of staff for directions. Shops: Each hospital contains a shop selling magazines, newspapers, sweets and drinks. Please ask a member of staff for directions. 13

14 14

15 15

16 Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on Produced by: Imaging Patient Information Group. Edition 3. Date implemented: March Review date: March (Mear) KR IMA